Quality Assurance Program

Paper instructions:

Case management programs are usually considered to be an element of the Quality Assurance Program. However, some health care professionals believe that they may be more interested in managing costs rather than quality of care. Considering this issue please respond to the following questions:

Do you believe that case management programs are more concerned with reducing costs or improving the quality of care? Please justify your position.
Generally discuss the limitations of a typical case management program and their strengths.
Do you believe that case management programs will become a medical program necessity in the future? Justify your position.
In your opinion, how important are “gatekeepers” to the case management process?


evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for quality assurance presented in this course.

In the earlier paper  you identified a health care facility for the subject of the paper and presented a description of the facility and it’s quality assurance program. You also critiqued the facility’s Continuous Quality Improvement program and the Utilization Management Program

In this module you will discuss and critique the subject facility’s Case Management program. The remaining modules for the Session Long Project the remaining tasks are as follows:

Describe and discuss the facility’s Case Management program.
Compare and critique the subject facility’s Case Management program to that of a model facility and whether the facility adheres to the recognized standard for case management, including disease state management.
Determine if the facility’s quality assurance program results in the patients being helped to maximize their health care benefits.
Identify areas for improvement in the facility’s Case Management program, if any, and any recommendations you think should be implemented to improve the quality of patient care

Anonymous (2010, June 8). Care coordination in medical homes, accountable care systems forecasts pivotal role for case managers. PR Newswire. Retrieved November 2012 from Proquest

Anonymous. (2009, June 16). URAC and CARF international announce new survey tool for health care case management studies. PR Newswire. Retrieved November 2012 from Proquest

Gold, M. R., Jacobson, G. A., & Garfield, R. L. (2012). There is little experience and limited data to support policy making on integrated care for dual eligibles. Health Affairs, 31(6), 1176-1185. Retrieved November 2012 from Proquest

Sanders, B. (2012). Managed care under the microscope. New Hampshire Business Review, 34(9), p. 1. Retrieved November 2012 from Proquest

Saunier, B. (2011). The devils in the details: Managed-care and the unforeseen costs of utilization review as a cost containment mechanism. Issues in Law & Medicine, 27(1), 21-49. Retrieved November 2012 from Proquest

Hospital case management and progression of care Stefani Daniels, Jeff Frater. Healthcare Financial Management. Westchester: Aug 2011. Vol. 65, Iss. 8; pg. 108, 6 pgs. Retrieved November 2012 from Proquest

URAC and CARF International Announce New Survey Tool for Health Care Case Management Studies Anonymous. PR Newswire. New York: June 16, 2009. Retrieved Nobember 2012 from Proquest

Commission for Case Manager Certification Unveils Knowledge Framework to Advance Policy and Workforce Development Anonymous. PR Newswire. New York: Apr 19. 2011. Retrieved November 2012 from Proquest

Optional Readings
Anonymous. (2008, October 6). KePRO partners with health hero network to improve health outcomes; Care management – supported by telehealth home monitoring of high cost members with acute and chronic conditions – to deliver cost savings for commercial and public clients. PR Newswire. Retrieved November, 2012 from Proquest


Case Management Focus Group Report, National Institute of Allergy and Infectious Diseases, National Institutes of Health. (n.d.). Retrieved November 2012 from http://www.niaid.nih.gov/dmid/malaria/malafr/case.htm

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